Coding for Mental Health and Behavioral Problems: The Arcane Elevated to the Ranks of the Scientific

In this issue of Pediatrics electronic pages, Rushton and colleagues¹ report their experience regarding the coding practices of pediatric generalists, developmental and behavioral pediatricians, and child and adolescent psychiatrists as related to behavioral and mental health issues. In their review, the phrase “alternate coding” is used to characterize the reality that physicians in different specialties will use different coding strategies to report the same patient encounter and diagnostic reality. There is some moralizing about the right way to do things and whether or not alternate coding can be characterized “simply as miscoding, gaming, or fraud.”

The Merriam Webster Dictionary² defines alternate as “substitute” or “that which is chosen in place of something else.” There is nothing in this characterization that suggests either appropriateness or accuracy. To determine whether or not “alternate coding” is an acceptable practice, it would be germane to review the existing administrative data and coding systems. Reporting data of a medical office encounter consists of 2 numeric codes—-a 5-digit procedural code (Current Procedural Terminology, Fourth Edition [CPT-IV])³ and a 3-, 4-, or 5-digit code that reports a diagnosis (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM]). CPT reports what was done and ICD-9-CM …

Address correspondence to Peter D. Rappo, MD, Pediatric Associates of Brockton, 370 Oak St, Brockton, MA 02301. Email: prappo{at}beansprout.net